Nasal fiberoptic intubation with and without split nasopharyngeal airway: Time to view the larynx & intubate

Background
Fiberoptic intubation requires long nasopharyngeal journey and mostly requiring jaw thrust to visualize larynx especially if done under general anesthesia. Use of split nasopharyngeal airway of appropriate length for better glottis visualization has been compared with the classic one.
Methods
Adult 68 patients; ASA I and II; undergoing surgery under general anesthesia were allocated randomly and equally into CL group in which classic nasal FOI with jaw thrust was done and NP group in which appropriate length of SNPA was inserted nasally followed by insertion of the scope with the application of jaw thrust if needed. Preprocedural heart rate, blood pressure and saturation and every minute for 5 min and also procedure and endoscopy time required to visualize the larynx (T1 and T3 respectively), carina (T4) and to remove the scope (T5) were recorded.
Results
Heart rate showed a statistically significant increase in CL and NP group during study time compared to pre-procedure reading. The MAP showed also statistical increase but only in CL group. There was a statistical (not clinical) significant increase between the percent of HR and MAP change in the CL group compared to NP group. T1, T3, and T5 in NP group were significantly shorter than in CL group but not for T4. Seven cases after SNPA needed jaw thrust.
Conclusion
Use of SNPA is safe and effective in reducing time to visualize larynx and intubate trachea. Developing longer specific “Naso-laryngeal (not nasopharyngeal) FOB intubating aid” is assumed to be more appropriate.